Mergers may enhance the legitimacy of community health organisations in neoliberal environments
Veronique Roussy, Grant Russell, Charles Livingstone, Therese Riley
School of Public Health and Preventive Medicine
Epidemiology and Preventive Medicine Alfred Hospital
Department of General Practice
Purpose: Comprehensive primary health care (PHC) models are seldom implemented in high income countries, in part due to their contested legitimacy in neoliberal policy environments. This article explores how merging affected the perceived legitimacy of independent community health organisations in Victoria, Australia, in providing comprehensive PHC services. Design/methodology/approach: A longitudinal follow-up study (2–3 years post-merger) of two amalgamations among independent community health organisations from the state of Victoria, Australia, was conducted. This article explores the perceived effects of merging on (1) the pragmatic, normative and cognitive legitimacy of studied organisations and (2) the collective legitimacy of these organisations in Victoria's health care system. Data were collected through 19 semi-structured interviews with key informants and subjected to template and thematic analyses. Findings: Merging enabled individual organisations to gain greater overall legitimacy as regional providers of comprehensive PHC services and thus retain some capacity to operationalise a social model of health. Normative legitimacy was most enhanced by merging, through acquisition of a large organisational size and adoption of business practices favoured by neoliberal norms. However, mergers may have destabilised the already contested cognitive legitimacy of community health services as a group of organisations and as a comprehensible state-wide platform of service delivery. Practical implications: Over-reliance on individual organisational behaviour to maintain the legitimacy of comprehensive PHC as a model of organising health and social care could lead to inequities in access to such models across communities. Originality/value: This study shows that organisations can manage their perceived legitimacy in order to ensure the survival of their preferred model of service delivery.
Journal of Health Organisation and Management
https://doi.org/10.1108/JHOM-04-2020-0160
Comprehensive primary health care
Institutional theory
10.1108/JHOM-04-2020-0160
Roussy, V., Russell, G., Livingstone, C., & Riley, T. (2021). Mergers may enhance the legitimacy of community health organisations in neoliberal environments. Journal of Health Organisation and Management, 35(6), 717-732. https://doi.org/10.1108/JHOM-04-2020-0160
Roussy, Veronique ; Russell, Grant ; Livingstone, Charles et al. / Mergers may enhance the legitimacy of community health organisations in neoliberal environments. In: Journal of Health Organisation and Management. 2021 ; Vol. 35, No. 6. pp. 717-732.
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title = "Mergers may enhance the legitimacy of community health organisations in neoliberal environments",
abstract = "Purpose: Comprehensive primary health care (PHC) models are seldom implemented in high income countries, in part due to their contested legitimacy in neoliberal policy environments. This article explores how merging affected the perceived legitimacy of independent community health organisations in Victoria, Australia, in providing comprehensive PHC services. Design/methodology/approach: A longitudinal follow-up study (2–3 years post-merger) of two amalgamations among independent community health organisations from the state of Victoria, Australia, was conducted. This article explores the perceived effects of merging on (1) the pragmatic, normative and cognitive legitimacy of studied organisations and (2) the collective legitimacy of these organisations in Victoria's health care system. Data were collected through 19 semi-structured interviews with key informants and subjected to template and thematic analyses. Findings: Merging enabled individual organisations to gain greater overall legitimacy as regional providers of comprehensive PHC services and thus retain some capacity to operationalise a social model of health. Normative legitimacy was most enhanced by merging, through acquisition of a large organisational size and adoption of business practices favoured by neoliberal norms. However, mergers may have destabilised the already contested cognitive legitimacy of community health services as a group of organisations and as a comprehensible state-wide platform of service delivery. Practical implications: Over-reliance on individual organisational behaviour to maintain the legitimacy of comprehensive PHC as a model of organising health and social care could lead to inequities in access to such models across communities. Originality/value: This study shows that organisations can manage their perceived legitimacy in order to ensure the survival of their preferred model of service delivery.",
keywords = "Australia, Community health, Comprehensive primary health care, Institutional theory, Legitimacy, Mergers",
author = "Veronique Roussy and Grant Russell and Charles Livingstone and Therese Riley",
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journal = "Journal of Health Organisation and Management",
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Roussy, V, Russell, G, Livingstone, C & Riley, T 2021, 'Mergers may enhance the legitimacy of community health organisations in neoliberal environments', Journal of Health Organisation and Management, vol. 35, no. 6, pp. 717-732. https://doi.org/10.1108/JHOM-04-2020-0160
Mergers may enhance the legitimacy of community health organisations in neoliberal environments. / Roussy, Veronique; Russell, Grant; Livingstone, Charles et al.
In: Journal of Health Organisation and Management, Vol. 35, No. 6, 08.10.2021, p. 717-732.
T1 - Mergers may enhance the legitimacy of community health organisations in neoliberal environments
AU - Roussy, Veronique
AU - Russell, Grant
AU - Livingstone, Charles
AU - Riley, Therese
N2 - Purpose: Comprehensive primary health care (PHC) models are seldom implemented in high income countries, in part due to their contested legitimacy in neoliberal policy environments. This article explores how merging affected the perceived legitimacy of independent community health organisations in Victoria, Australia, in providing comprehensive PHC services. Design/methodology/approach: A longitudinal follow-up study (2–3 years post-merger) of two amalgamations among independent community health organisations from the state of Victoria, Australia, was conducted. This article explores the perceived effects of merging on (1) the pragmatic, normative and cognitive legitimacy of studied organisations and (2) the collective legitimacy of these organisations in Victoria's health care system. Data were collected through 19 semi-structured interviews with key informants and subjected to template and thematic analyses. Findings: Merging enabled individual organisations to gain greater overall legitimacy as regional providers of comprehensive PHC services and thus retain some capacity to operationalise a social model of health. Normative legitimacy was most enhanced by merging, through acquisition of a large organisational size and adoption of business practices favoured by neoliberal norms. However, mergers may have destabilised the already contested cognitive legitimacy of community health services as a group of organisations and as a comprehensible state-wide platform of service delivery. Practical implications: Over-reliance on individual organisational behaviour to maintain the legitimacy of comprehensive PHC as a model of organising health and social care could lead to inequities in access to such models across communities. Originality/value: This study shows that organisations can manage their perceived legitimacy in order to ensure the survival of their preferred model of service delivery.
AB - Purpose: Comprehensive primary health care (PHC) models are seldom implemented in high income countries, in part due to their contested legitimacy in neoliberal policy environments. This article explores how merging affected the perceived legitimacy of independent community health organisations in Victoria, Australia, in providing comprehensive PHC services. Design/methodology/approach: A longitudinal follow-up study (2–3 years post-merger) of two amalgamations among independent community health organisations from the state of Victoria, Australia, was conducted. This article explores the perceived effects of merging on (1) the pragmatic, normative and cognitive legitimacy of studied organisations and (2) the collective legitimacy of these organisations in Victoria's health care system. Data were collected through 19 semi-structured interviews with key informants and subjected to template and thematic analyses. Findings: Merging enabled individual organisations to gain greater overall legitimacy as regional providers of comprehensive PHC services and thus retain some capacity to operationalise a social model of health. Normative legitimacy was most enhanced by merging, through acquisition of a large organisational size and adoption of business practices favoured by neoliberal norms. However, mergers may have destabilised the already contested cognitive legitimacy of community health services as a group of organisations and as a comprehensible state-wide platform of service delivery. Practical implications: Over-reliance on individual organisational behaviour to maintain the legitimacy of comprehensive PHC as a model of organising health and social care could lead to inequities in access to such models across communities. Originality/value: This study shows that organisations can manage their perceived legitimacy in order to ensure the survival of their preferred model of service delivery.
KW - Australia
KW - Comprehensive primary health care
KW - Institutional theory
KW - Legitimacy
KW - Mergers
U2 - 10.1108/JHOM-04-2020-0160
DO - 10.1108/JHOM-04-2020-0160
JO - Journal of Health Organisation and Management
JF - Journal of Health Organisation and Management
Roussy V, Russell G, Livingstone C, Riley T. Mergers may enhance the legitimacy of community health organisations in neoliberal environments. Journal of Health Organisation and Management. 2021 Oct 8;35(6):717-732. https://doi.org/10.1108/JHOM-04-2020-0160